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Att vara förälder till ett för tidigt fött barn: en prospektiv studie om upplevelsen av föräldraskap och möten med vården
Örebro University, Department of Health Sciences.
2005 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Parenting a prematurely born child : a prospective study of the experiences of parenthood and interaction with health care professionals (English)
Abstract [en]

The present doctoral thesis focuses mainly on the experiences of 20 women and men of becoming and being parents of a prematurely born child and on their perceptions of their contacts with health and medical care services. An additional aim was to investigate the utilisation of health care during the first year of life and its relation to high-risk diagnoses in the neonatal period.

Data were obtained by interviews of the 20 sets of parents to infants born at a gestational age of <34 weeks with no serious congenital defects. These parents were interviewed 1-2 weeks after the infant’s birth and at 2, 6 and 18 months of age. The interview texts were subjected to phenomenological and content analysis. Data was also obtained from the records of 36 infants born at a gestational age of <31 weeks and with a birth weight of <1500 g and 36 full-term infants. The records included information regarding contact with health care services including the child health centres (CHCs) and the outpatient clinics of the paediatric and ophthalmic clinics. Finally data from the other two quantitative studies were obtained from three questionnaires: Quality of Care from The Patient’s Perspective, The Swedish Parenthood Stress Questionnaire and The Toddler Behaviour Questionnaire.

The result of the studies showed that the utilisation of health care by the very low birth weight infants was higher than that by the fullterm infants in paediatric and ophthalmic outpatient clinics. High-risk diagnoses in the neonatal period did not correlate with utilisation of care except for visits to the paediatric outpatient clinic, especially planned visits.

The internalisation of parenthood was described by the parents as a time-dependent process, with four syntheses of experiences – alienation, responsibility, confidence and familiarity.

The development and construction of the mothers’ and fathers’ parental identity followed a pattern that could be summarised into three themes: Unexpected start of parenthood, integration of parenthood into the sense of identity and recognition of parental identity. Important turning points in experiences of parenthood often occurred when the infant could be removed from the incubator, when it was discharged from the ward, and when the infant appeared normal compared to full-term infants.

The quality of care was judged, from the parents’ and nurses’ perspective. In general the subjective importance of the given care was rated higher than the care actual given in both neonatal care and care at the CHCs. Higher ratings were given to neonatal care compared with the care at CHSs for medico-technical competence. It was also of importance, of both parents, to receive an optimal identity-oriented approach and socio-cultural atmosphere in the neonatal care and the care at the CHSs. High-risk diagnoses in the newborn did not affect the answers.

Parental stress of very preterm children, at 18 months of age, did not differ notably from those parents of children born somewhat less premature, but they assessed their children as being rather later in the development of social behaviours. Parents of children who had had a difficult neonatal period were not more stressed when the child was 18 months old than those who had no problems in the neonatal period.

In sum, this research project showed that the parents’ expectations and experiences of becoming mothers and fathers in preterm birth was a process of integrating the unexpected start of parenthood into the parents’ sense of identity and their way of being. When the parents developed a relationship with the infant, actively participated in its care on the basis of their own preferences, and received recognition as parents, this process was strengthened. It is therefore important that the professional caring of the staff should meet and involve the natural caring of the parents.

Place, publisher, year, edition, pages
Örebro: Örebro universitetsbibliotek , 2005. , 137 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 2
Keyword [en]
Preterm infant, utilisation of health care, quality of care, parental identity, parental stress, toddlers behaviour
National Category
Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
URN: urn:nbn:se:oru:diva-197ISBN: 91-7668-460-1 (print)OAI: oai:DiVA.org:oru-197DiVA: diva2:135716
Public defence
2005-12-16, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2005-11-28 Created: 2005-11-28 Last updated: 2014-09-24Bibliographically approved
List of papers
1. Utilization of healthcare by very-low-birthweight infants during their first year of life
Open this publication in new window or tab >>Utilization of healthcare by very-low-birthweight infants during their first year of life
2001 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 90, no 2, 213-217 p.Article in journal (Refereed) Published
Abstract [en]

New knowledge in perinatal medicine has resulted in increased survival of very-low-birthweight (VLBW) infants. After leaving hospital, the child is seen at regular medical check-ups, but there is often a persistent worry about the child which affects the family as a whole. This can lead to an increased utilization of healthcare. Our objective was therefore to describe the utilization of healthcare by VLBW infants during their first year of life and its relation to high-risk diagnoses in the neonatal period. The study group comprised 36 infants born at gestational ages of < or = 31 wk and with a birthweight of < or = 1500 g, and was compared with a control group of 36 full-term infants. Utilization of healthcare by the VLBW infants was higher than that by the control group in paediatric and ophthalmic outpatient clinics. The total number of contacts with healthcare was on average 38.7 versus 17.4. High-risk diagnoses in the neonatal period did not correlate with utilization of care, except for visits to the paediatric outpatient clinic, especially planned visits. Further studies focusing on how to support these families after leaving hospital are therefore needed.

Keyword
Neonatal care;very-low-birthweight infants;utilization of healthcare
National Category
Nursing
Research subject
Nursing Science; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-2947 (URN)10.1111/j.1651-2227.2001.tb00286.x (DOI)000167243800019 ()11236053 (PubMedID)2-s2.0-0035103687 (Scopus ID)
Available from: 2005-11-28 Created: 2005-11-28 Last updated: 2016-12-12Bibliographically approved
2. From alienation to familiarity: experiences of mothers and fathers of preterm infants
Open this publication in new window or tab >>From alienation to familiarity: experiences of mothers and fathers of preterm infants
2003 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 43, no 2, 120-129 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The birth of a preterm infant has a long-term impact on both parents. Mothers report more stress and poor adjustment compared with fathers. Influencing factors, such as family situation and health status of the child, can support or weaken the coping ability of the parents. Studies on experiences of fathers are sparse.

AIM: The aim of this research was to study how mothers and fathers of preterm infants describe their experiences of parenthood during the infant's first 18 months of life.

METHODS: Seven consecutively selected sets of parents of preterm infants born at </=34 weeks of gestation with no serious congenital defects were interviewed 1-2 weeks after the infant's birth and at 2, 6 and 18 months of age, and the findings were analysed using a phenomenological method.

FINDINGS: Internalization of parenthood was described as a time-dependent process, with four syntheses of experiences - alienation, responsibility, confidence and familiarity. Within the syntheses, similarities in how mothers and fathers described their parental roles involved concern for the child, insecurity, adjustment and relationship with the child. Regarding differences, mothers experienced having more responsibility and control of the care and a need to be confirmed as a mother, while fathers described confidence in leaving the care to the staff and wanted to find a balance between work and family life. Important turning points in parenthood experiences often occurred when the infant could be removed from the incubator, discharged from the ward, and when the infant looked normal compared to full-term infants.

CONCLUSIONS: The structure of the phenomenon of parenthood was formed by the integration of the syntheses of alienation, responsibility, confidence and familiarity. The structure seems to be based on the parents' expectations of the parental role, the infant's health condition and the health care environment. These interacting factors are influenced by cultural beliefs.

Keyword
low birth weight infant;parenting;support;coping;family functioning;mother;father;nursing care
National Category
Nursing
Research subject
Nursing Science; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-2948 (URN)10.1046/j.1365-2648.2003.02686.x (DOI)000183894900001 ()12834369 (PubMedID)2-s2.0-0041851026 (Scopus ID)
Available from: 2005-11-28 Created: 2005-11-28 Last updated: 2014-09-25Bibliographically approved
3. Development and construction of parental identity in preterm birth: qualitative analysis of mothers' and fathers' narratives
Open this publication in new window or tab >>Development and construction of parental identity in preterm birth: qualitative analysis of mothers' and fathers' narratives
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-15755 (URN)
Available from: 2011-05-31 Created: 2011-05-31 Last updated: 2014-09-25Bibliographically approved
4. Quality of care of the preterm infant: the parent and nurse perspective
Open this publication in new window or tab >>Quality of care of the preterm infant: the parent and nurse perspective
2006 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, no 1, 29-37 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To study the subjective opinions about what is important in care at neonatal units and child health centres (CHCs) for premature newborns, and to compare these opinions with the care actually given. SUBJECTS: 21 mothers, 20 fathers and 15 nurses at the neonatal unit, and 21 mothers, 14 fathers and 18 nurses at CHCs.

METHODS: A questionnaire on quality of Care from the Patient's Perspective was used. It contained three dimensions: identity-oriented approach, medical-technical competence and socio-cultural atmosphere. Each dimension was evaluated in terms of subjective importance and perceived reality of given care.

RESULTS: In general, subjective importance was rated higher than perceived reality both for neonatal care and care at CHCs for the dimensions identity-oriented approach and medical-technical competence. However, higher ratings were given to neonatal care compared to CHCs for medical-technical competence. High-risk diagnoses and very low gestational age in the newborn did not affect the answers. Mothers rated medical-technical competence higher than nurses for neonatal care. Mothers and nurses rated identity-oriented approach higher than fathers for CHCs.

CONCLUSION: Although both neonatal care and care at CHCs were highly rated, improvements can be made to fulfil the expectations of parents and nurses. Neonatal units seem to be more efficient in taking care of the special needs of these newborns compared to CHCs. The need for an optimal identity-oriented approach, medical-technical competence and socio-cultural atmosphere could strengthen the possibilities of parents to be confident in their parental role.

Place, publisher, year, edition, pages
Oslo: Taylor & Francis, 2006
Keyword
health care, neonatal care, preterm infant, quality of care
National Category
Other Medical Sciences not elsewhere specified Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-11167 (URN)10.1111/j.1651-2227.2006.tb02176.x (DOI)000234121900006 ()16373293 (PubMedID)2-s2.0-29944438089 (Scopus ID)
Available from: 2010-06-18 Created: 2010-06-18 Last updated: 2014-09-25Bibliographically approved
5. Parental stress and toddler behaviour at age 18 months after pre-term birth
Open this publication in new window or tab >>Parental stress and toddler behaviour at age 18 months after pre-term birth
2007 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 2, 227-232 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To describe the parent's judgement of their own stress and the child's behaviour at 18 months after pre-term birth and if there are any correlations between these assessments, the morbidity in the neonatal period, the gestational age at birth and the occurrence of twin/triplet births. METHOD: Twenty-one mothers and 19 fathers of pre-term infants answered two questionnaires, The Swedish Parenthood Stress Questionnaire (SPSQ) and The Toddler Behaviour Questionnaire (TBQ). RESULTS: Mothers scored somewhat higher than fathers concerning parental stress. Parents with twins/triplets and of children born in gestational week 25-30 felt more stress, though the differences were not statistically significant. High-risk diagnoses did not correlate to any of the dimensions. The parents judged the behaviour of the children similar except that parents of children born in gestational week 25-30 scored significantly higher for intensity/activity (p = 0.002). The correlation between parental stress and judgement of their children's behaviour did not show any significant association except for the dimension regularity in TBQ (p = 0.016). CONCLUSIONS: The mothers' and fathers' assessments of their own stress and of the children's behaviour were similar. Parents of very pre-term children felt more stress and judged the children somewhat delayed in their social behaviours, probably due to their low gestational age.

Place, publisher, year, edition, pages
Oslo: Taylor & Francis, 2007
Keyword
Parental stress;Pre-term infant;Toddler behaviour
National Category
Pediatrics Nursing
Research subject
Pediatrics; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-5640 (URN)10.1111/j.1651-2227.2007.00015.x (DOI)000243993800018 ()17429910 (PubMedID)2-s2.0-33847192852 (Scopus ID)
Available from: 2009-02-17 Created: 2009-02-17 Last updated: 2014-09-24Bibliographically approved

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